August 5, 2009 (American Roentgen Ray Society) - Noninvasive imaging (MRI) may aid physicians in the early diagnosis, staging and treatment of diabetes, according to a study performed at Massachusetts General Hospital and Harvard Medical School in Boston, MA. This is the first study of its kind to apply noninvasive imaging techniques to diabetes research."With noninvasive MRI we have the ability to evaluate beta cell mass, a major factor of insulin secretion that is significantly reduced in type two diabetes and almost gone in type one," said Anna Moore, MD, lead author of the study. "We are also able to detect inflammation of the pancreas and vascular changes associated with type one and type two diabetes. This opens a huge area that is closed right now," said Dr. Moore.

"Knowing the number of functional beta cells left would allow physicians to develop the most appropriate treatment plans for their patients. It would also allow them to respond, change or manipulate those treatment plans at any time," she said.

"Noninvasive MRI could no doubt tremendously assist in achieving insulin independence in patients with diabetes," said Dr. Moore.

This study appears in the August issue of the American Journal of Roentgenology.

July 29, 2009 (EurekAlert) - The Juvenile Diabetes Research Foundation, a leader in setting the agenda for diabetes research worldwide and the largest charitable funder and advocate of type 1 research, announced today that it has launched an on-line service for people with type 1 diabetes and their families to easily find information about clinical trials for drugs, treatments, and therapeutics for diabetes and its complications.The on-line service, JDRF's Clinical Trials Connection, will enable people to search the database of trials of the National Institutes of Health (including JDRF-funded trials) that involve diabetes cures and treatments to get information, make comparisons, and - if they are interested - directly contact trial centers. It is available at www.trials.jdrf.org.

Through this web site, people can provide criteria like the type of trial they are interested in, how long they have had diabetes, and how far they'd be willing to travel, and the site will let them know about studies that match those characteristics. Clinical Trials Connection can help them search for trials, compare one trial with another, and update them on new trials that might match their interest. Plus, the service provides contact information for the researchers conducting the trial, so people interested in trials can contact them directly for more information, after discussing options with their healthcare provider.

The quickly increasing number of clinical trials, and the overall progress in diabetes research, make it harder for people with diabetes to keep up-to-date on what trials are available, and to make decisions on whether or not to participate in a study. People tell JDRF a simple-to-use service to find and compare trials would be a significant benefit to them; in fact, more than 5,000 people have pre-registered for the site.

At the same time, Clinical Trials Connection will help advance JDRF's research agenda, which is funding more human clinical trials than ever before, but finding it tougher and tougher to enroll participants in a timely and cost-efficient way.

Over its almost 40 years of history, the Juvenile Diabetes Research Foundation International has funded more than $1.3 billion in research to find a cure for type 1 diabetes, accelerating the pace of science leading to a cure to the point where it is today funding more than 40 human clinical trials of drugs, compounds, and therapeutics.

But what should be terrific news for the almost 3 million people in the U.S. with this life-long autoimmune disease, is only bittersweet, as diabetes researchers are finding it difficult to recruit enough participants to take part in trials quickly and cost-effectively.

Among a number of ways to promote the free service, JDRF is focusing one of its public service announcement advertisements on encouraging people to take part in the search for a cure by finding out about clinical trial opportunities. The theme of the campaign is "What does hope look like?" The answer is that it looks like children and adults with type 1 diabetes taking an active role in science leading to a cure.

The campaign includes 60-second and 30-second television and radio spots, as well as print, billboard, and online banner ads. They feature Mary Tyler Moore, the International Chairman of JDRF who was diagnosed with type 1 diabetes as an adult, and a group of children, teens, and adults with diabetes who have taken part in clinical trials. The campaign launched earlier this year.

The ads direct people with type 1 diabetes and their families to JDRF's Clinical Trials Connection.

In type 1 diabetes, the immune systems stops a person's pancreas from producing insulin, the hormone that enables people to get energy from food. To survive, people with type 1 diabetes must test their blood sugar levels multiple times per day by pricking their fingers to draw blood, and then administering insulin through multiple daily injections, or the use of a continuous infusion insulin pump.

While trying to balance insulin with the amount of food eaten (which raises blood sugar) and exercise (which lowers blood sugar), people with type 1 diabetes must constantly be prepared for potential life-threatening low or high blood sugar levels. Just as devastating, the long-term complications of diabetes include blindness, heart attack, kidney failure, stroke, nerve damage and amputations. While usually diagnosed in childhood, type 1 diabetes can also be diagnosed in adults.

June 4, 2009 (Lantheus Medical Imaging) - Lantheus Medical Imaging, Inc., a worldwide leader in diagnostic imaging, announced today that the company's leading imaging agent, Cardiolite® (Kit for the Preparation of Technetium Tc99m Sestamibi for Injection), was used in a recently completed five-year study examining appropriate treatment regimens for patients with type 2 diabetes and coronary artery disease. The results of this study, known as The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), will be presented by the University of Pittsburgh Graduate School of Public Health at a special symposium on Sunday, June 7, 2009, from 4:15 pm - 5:15 pm (CT) at the American Diabetes Association 69th Scientific Sessions in New Orleans.In the study, SPECT myocardial perfusion imaging (MPI) with Cardiolite® was used to objectively identify coronary artery disease during initial patient recruitment and for subsequent one, three and five-year follow-up of patients enrolled in the study to determine the impact of therapy on left ventricular ejection fraction (LVEF), ischemic burden and scar. One of the two primary objectives for the BARI 2D study was to determine if a strategy of initial elective coronary revascularization combined with aggressive medical therapy results in a lower five-year mortality compared with a strategy of initial aggressive medical therapy alone. Lantheus Medical Imaging, Inc. provided support for the study.

"As the number of patients affected by a combination of type 2 diabetes and coronary artery disease continues to rapidly increase, the results of the BARI 2D study could potentially impact millions and better inform patient management decisions as clinicians seek to establish the best possible course of treatment for this growing patient population," stated Don Kiepert, president and chief executive officer of Lantheus Medical Imaging, Inc. "We are proud to have supported and supplied our product for this pivotal clinical effort and recognize the importance of improving treatment protocols for patients with type 2 diabetes to manage cardiovascular risk and prevent further complications."

About Cardiolite®
Cardiolite® (Kit for the Preparation of Technetium Tc99m Sestamibi for Injection) is one of the world's most widely-used cardiac imaging agents and the only technetium labeled myocardial perfusion agent that has been used to image more than 40 million patients. For almost two decades, Cardiolite® has played a vital role in the diagnosis and management of patients with known or suspected coronary artery disease.

Cardiolite® is the first technetium labeled myocardial perfusion tracer to provide physicians with prognostic information that can be helpful in making patient management decisions. Cardiolite® is the subject of more than 10,000 publications and the imaging agent of choice within several post marketing cardiology clinical trials -DIAD, COURAGE, ERASE, INSPIRE and CHRISTMAS - which have resulted in changes in patient care. Cardiolite® leads the way with the most FDA approved clinical indications as a myocardial perfusion imaging agent.

Indication and Important Safety Information Regarding Cardiolite®
Cardiolite® (Kit for the Preparation of Technetium Tc99m Sestamibi for Injection) is a myocardial perfusion agent that is indicated for detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects), in evaluating myocardial function and developing information for use in patient management decisions. Cardiolite® evaluation of myocardial ischemia can be accomplished with rest and cardiovascular stress techniques (e.g., exercise or pharmacologic stress in accordance with the pharmacologic stress agent's labeling).

It is usually not possible to determine the age of a myocardial infarction or to differentiate a recent myocardial infarction from ischemia. Exercise and pharmacologic stress testing should be performed only under the supervision of a qualified physician. Cardiolite® has been rarely associated with acute severe allergic events of angioedema and urticaria. The most frequently reported adverse events include headache, chest pain/angina, ST segment changes on ECG, nausea, and abnormal taste and smell.

For full prescribing information, please visit www.cardiolite.com. Cardiolite® is a registered trademark of Lantheus Medical Imaging, Inc.

About Lantheus Medical Imaging, Inc.
Lantheus Medical Imaging, Inc., a worldwide leader in diagnostic medicine for the past 50 years, is committed to advancing and investing in the field of diagnostic imaging. The company's proven success in discovering, developing and marketing innovative medical imaging agents provides a solid platform from which to bring forward breakthrough new tools for the diagnosis and management of disease. The company is home to leading cardiac imaging brands, including Cardiolite® (Kit for the Preparation of Technetium Tc99m Sestamibi for Injection), DEFINITY® Vial For (Perflutren Lipid Microsphere) Injectable Suspension, and TechneLite® (Technetium Tc99m Generator) and has nearly 700 employees worldwide with headquarters in North Billerica, Massachusetts, and offices in Puerto Rico, Canada, and Australia. For more information, visit www.lantheus.com.

June 3, 2009 (Newswise) - An extract of ginkgo biloba shows scientific evidence of effectiveness against one common and hard-to-treat type of pain, according to animal data reported in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).Dr. Yee Suk Kim and colleagues of The Catholic University of Seoul, South Korea, performed experiments in rats to evaluate the effectiveness of ginkgo against neuropathic pain, a common pain problem associated with herpes zoster, limb injury, or diabetes. Affected patients may feel severe pain in response to harmless stimuli like heat, cold, or touch.

Objective Evidence of Pain Reduction with Ginkgo
In the experiments, rats with neuropathic pain were treated with different doses of a standardized ginkgo biloba extract or with an inactive solution. Objective tests were performed to see how ginkgo affected neuropathic pain responses to cold and pressure.

For both cold and pressure stimuli, pain responses were significantly reduced in ginkgo-treated rats. This was so on before-and-after treatment comparisons and on comparison of ginkgo-treated versus placebo-treated animals. The higher the dose of ginkgo extract, the greater the pain-relieving effect. Pain was reduced for at least two hours after ginkgo treatment.

The study provides no evidence as to how ginkgo works to reduce pain. Several mechanisms are possible, including antioxidant activity, an anti-inflammatory effect, or protection against nerve injury-perhaps in combination.

Many herbs and "alternative" drugs are commonly used without prescriptions for a wide range of purposes, despite a lack of scientific evidence for health claims. Ginkgo, one of the most popular herbal products, is widely used as a memory enhancer, among other purposes.

The new study provides the first scientific evidence that ginkgo has a real effect in reducing neuropathic pain. New treatments are needed for neuropathic pain, which does not always respond well to available treatments.

"It's still too early to stock up on ginkgo biloba if you have chronic pain," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. Many treatments that are effective in animals do not prove to be effective in humans, or prove to have unacceptable toxic effects when given to patients, Dr. Shafer reminds. "However," he adds, "it is at least reassuring to know that scientists are investigating the properties of this ancient oriental herbal medication in an effort to determine what chemical constituents account for the many beneficial effects traditionally ascribed to it."

March 12, 2009 (EurekAlert) - Too little vitamin D could be bad for more than your bones; it may also lead to fatter adolescents, researchers say.A Medical College of Georgia study of more than 650 teens age 14-19 has found that those who reported higher vitamin D intakes had lower overall body fat and lower amounts of the fat in the abdomen, a type of fat known as visceral fat, which has been associated with health risks such as heart disease, stroke, diabetes and hypertension.

The group with the lowest vitamin D intake, black females, had higher percentages of both body fat and visceral fat, while black males had the lowest percentages of body and visceral fat, even though their vitamin D intake was below the recommended levels. Only one group - white males - was getting the recommended minimum intake of vitamin D.

"This study was a cross-section so, while it cannot prove that higher intake of vitamin D caused the lower body fat, we know there is a relationship that needs to be explored further," says Dr. Yanbin Dong, a molecular geneticist and cardiologist at the MCG Gerogia Prevention Institute.

Dr. Dong, who also co-directs the MCG Diabetes & Obesity Discovery Institute, and Inger Stallman-Jorgensen, a research dietician at the GPI, present their findings this week at the American Heart Association's Joint 49th Conference on Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity and Metabolism in Palm Harbor, Fla.

The pair will next study whether it is feasible for teens to take a daily vitamin D supplement in pill form. Those results will help them design a larger study to explore the relationship between vitamin D intake and body fat levels in teens.

"We already know that encouraging teens to get an adequate amount of vitamin D in their diets will help promote a healthy body as they grow and develop," Ms. Stallman-Jorgensen says. "Now we need to do intervention studies where we give teens vitamin D supplements to determine if there is a cause and effect relationship between vitamin D intake and fat."

The American Academy of Pediatrics recommends adolescents get at least 400 units of vitamin D per day - either from milk or sun exposure. There are typically 100 units in one 8-ounce glass of whole milk. The recommended daily dose from the sun would require at least 30 minutes of adequate exposure to direct sunlight two or three times a week at peak hours, between noon and 3 p.m.

Ms. Stallman-Jorgensen said there are many reasons teens don't get enough vitamin D, which has been linked to the prevention of diabetes, cancer and cardiovascular disease.

"As humans, our largest source of vitamin D should be the sun. But we don't spend enough time outdoors to get enough sun exposure and when we do, we're often covered up and wearing sunscreen," she said. "We can get vitamin D from certain foods, like fatty fish and liver, but it's not in a lot of foods that we commonly consume. In this country, our milk is fortified with vitamin D. Unfortunately, teens just don't drink enough milk to get their daily requirements."

She points out that low sunlight during the winter months reduces the amount of vitamin D the skin produces, and that darker-skinned people obtain less vitamin D from the sun because the extra melanin in their skin filters out more sunlight.

Some people can't tolerate milk because they lack the enzyme that processes lactose, the natural sugar in milk, though "most people can handle it in small amounts," Ms. Stallman says.

Cultural issues may also be at play, Ms. Stallman-Jorgensen says.

"Most teens want to drink sodas and sugary drinks. It's not cool to drink milk - they think of it as more of a food for babies," she said.

Potential study participants had their weekday and weekend diets tracked by researchers seven times during a three-month period. Those who provided at least four diet reports were included in the final group of 659.

Body fat percentages were measured by dual energy X-ray absorptiometry scans, which can measure total body composition. Visceral was measured in a subset of 432 teens.

March 12, 2009 (EurekAlert) - UC Irvine researchers have discovered that circadian rhythms - our own body clock - regulate energy levels in cells. The findings have far-reaching implications, from providing greater insights into the bond between the body's day-night patterns and metabolism to creating new ways to treat cancer, diabetes, obesity and a host of related diseases.In addition, Paolo Sassone-Corsi, Distinguished Professor and Chair of Pharmacology, and his colleagues found that the proteins involved with circadian rhythms and metabolism are intrinsically linked and dependent upon each other. Their study appears online in Science Express.

"Our circadian rhythms and metabolism are closely partnered to ensure that cells function properly and remain healthy," Sassone-Corsi said. "This discovery opens a new window for us to understand how these two fundamental processes work together, and it can have a great impact on new treatments for diseases caused by cell energy deficiencies."

Circadian rhythms of 24 hours govern fundamental physiological functions in almost all organisms. The circadian clocks are the essential time-tracking systems in our bodies that anticipate environmental changes and adapt to the appropriate time of day. Disruption of these rhythms can profoundly influence human health and has been linked to obesity, diabetes, insomnia, depression, coronary heart diseases and cancer.

Sassone-Corsi already had identified that the enzyme protein CLOCK is an essential molecular gear of the circadian machinery and interacts with a protein, SIRT1, which senses cell energy levels and modulates aging and metabolism.

In this study, he and his colleagues show that CLOCK works in balance with SIRT1 to direct activity in a cell pathway by which metabolic proteins send signals called the NAD+ salvage pathway. In turn, a key protein in that pathway, NAMPT, helps control CLOCK levels, creating a tightly regulated codependency between our circadian clock and metabolism.

"When the balance between these two vital processes is upset, normal cellular function can be disrupted," Sassone-Corsi said. "And this can lead to illness and disease."

The findings suggest that proper sleep and diet may help maintain or rebuild this balance, he said, and also help explain why lack of rest or disruption of normal sleep patterns can increase hunger, leading to obesity-related illnesses and accelerated aging.

The specific interaction between CLOCK and SIRT1 and the NAD+ salvage pathway also presents a starting point for drug development aimed at curbing cell dysfunction and death, thereby helping to solve major medical problems such cancer and diabetes.

January 20, 2009 - (EurekAlert) - People on low-carbohydrate diets are more dependent on the oxidation of fat in the liver for energy than those on a low-calorie diet, researchers at UT Southwestern Medical Center have found in a small clinical study.The findings, published in the journal Hepatology, could have implications for treating obesity and related diseases such as diabetes, insulin resistance and nonalcoholic fatty liver disease, said Dr. Jeffrey Browning, assistant professor in the UT Southwestern Advanced Imaging Research Center and of internal medicine at the medical center.

"Instead of looking at drugs to combat obesity and the diseases that stem from it, maybe optimizing diet can not only manage and treat these diseases, but also prevent them," said Dr. Browning, the study's lead author.

Although the study was not designed to determine which diet was more effective for losing weight, the average weight loss for the low-calorie dieters was about 5 pounds after two weeks, while the low-carbohydrate dieters lost about 9½ pounds on average.

Glucose, a form of sugar, and fat are both sources of energy that are metabolized in the liver and used as energy in the body. Glucose can be formed from lactate, amino acids or glycerol.

In order to determine how diet affects glucose production and utilization in the liver, the researchers randomly assigned 14 obese or overweight adults to either a low-carbohydrate or low-calorie diet and monitored seven lean subjects on a regular diet.

After two weeks, researchers used advanced imaging techniques to analyze the different methods, or biochemical pathways, the subjects used to make glucose.

"We saw a dramatic change in where and how the liver was producing glucose, depending on diet," said Dr. Browning.

Researchers found that participants on a low-carbohydrate diet produced more glucose from lactate or amino acids than those on a low-calorie diet.

"Understanding how the liver makes glucose under different dietary conditions may help us better regulate metabolic disorders with diet," Dr. Browning said.

The different diets produced other differences in glucose metabolism. For example, people on a low-calorie diet got about 40 percent of their glucose from glycogen, which is comes from ingested carbohydrates and is stored in the liver until the body needs it.

The low-carbohydrate dieters, however, got only 20 percent of their glucose from glycogen. Instead of dipping into their reserve of glycogen, these subjects burned liver fat for energy.

The findings are significant because the accumulation of excess fat in the liver - primarily a form of fat called triglycerides - can result in nonalcoholic fatty liver disease, or NAFLD. The condition is the most common form of liver disease in Western countries, and its incidence is growing. Dr. Browning has previously shown that NAFLD may affect as many as one-third of U.S. adults. The disease is associated with metabolic disorders such as insulin resistance, diabetes and obesity, and it can lead to liver inflammation, cirrhosis and liver cancer.

"Energy production is expensive for the liver," Dr. Browning said. "It appears that for the people on a low-carbohydrate diet, in order to meet that expense, their livers have to burn excess fat."

Results indicate that patients on the low-carbohydrate diet increased fat burning throughout the entire body.

Dr. Browning and his colleagues will next study whether the changes that occur in liver metabolism as a result of carbohydrate restriction could help people with nonalcoholic fatty liver disease. Previous research has shown a correlation between carbohydrate intake and NAFLD.

January 16, 2009 (EurekAlert) - Researchers at the University of Pittsburgh School of Medicine, funded by JDRF, have discovered that adult beta cells have the ability to replicate with the help of a protein known as cdk6. This research was led by Andrew F. Stewart, M.D., a Professor of Medicine and Chief of the Division of Endocrinology and Metabolism at the University of Pittsburgh School of Medicine. The complete findings of this discovery can be found in the early online version of Diabetes."Most scientists thought that these important pancreatic cells could not be induced to regenerate, or could only replicate very slowly," explained Dr. Stewart. "This work provides proof-of-principle that the production of human beta cells can be stimulated, and that those newly-generated cells function effectively both in the lab and in a living animal."

The ability of cells including human beta cells to divide or replicate is controlled by a series of events known as the cell cycle or cell division cycle. Pittsburgh researchers have taken steps to map comprehensively the proteins regulating the cell cycle in human beta cells. They examined 34 different proteins and found that cyclin dependent kinase- 6 (cdk6) alone or with cyclin D, when injected into human islets by viral delivery methods, triggered the beta cells to replicate. These transduced islets were then transplanted into diabetic mice for six weeks. The transplanted islet cells with cdk6 and cyclin D performed better than control (non-modified) human islets as measured by blood glucose levels and glucose tolerance tests in the transplanted animals. Researchers removed the transplanted cells after the six week study and confirmed that the human beta cells replicated in the transplant model.

"The question as to whether and how human beta cells can be induced to proliferate is a fundamentally important one for JDRF's Regeneration Program. Dr. Stewart and his colleagues address this question by demonstrating that modulation of specific cell cycle control proteins stimulates human beta cell replication. By identifying the control points for human beta cell cycle progression, Dr. Stewart and his colleague provide new insights and open up potentially new avenues in the search for therapies to promote beta cell regeneration in individuals with type 1 diabetes,", said Patricia Kilian, Ph.D., Therapeutic Program Director for Regeneration research at JDRF.

The ability to replicate adult human beta cells in an animal model and in vitro allows researchers the opportunity to fully understand and break down the components of cell replication. This research combines two therapeutic goals of the organization, regeneration and replacement therapy.

January 16, 2009 (EurekAlert) - The gene mediates insulin secretion indirectly via the release of melatonin, which implicates a previously unknown relationship between the sleep-wake rhythm and the fasting glucose level. The finding could open up new possibilities of treatment which go far beyond the primarily symptomatic therapy approaches to diabetes that have been practised until now.Diabetes mellitus and diabetes-associated late complications are among the most frequent chronic diseases and causes of death worldwide. In Germany there are approximately six million people with type 2 diabetes who are aware that they have the disease. In addition, there is a relatively high estimated number of undiagnosed diabetics. Besides lifestyle factors such as overweight and lack of exercise, genetic factors play an important role in the pathogenesis of this disease.

The international MAGIC Consortium (MAGIC = Meta-Analyses of Glucose and Insulin-related traits Consortium) combined the data from 13 case-control studies with over 18,000 diabetic and 64,000 non-diabetic study participants and was able to identify a variant of the MTNR1B gene which is associated with both elevated fasting glucose levels as well an elevated risk for type 2 diabetes. The goal of the MAGIC Consortium is to identify gene variants which regulate the fasting glucose levels in healthy individuals.

The study results were published in the January issue of Nature Genetics.

Germany is represented within the framework of the KORA studies by scientists of the Helmholtz Zentrum München (Assistant Professor Thomas Illig; Director of the KORA studies: Professor H.-Erich Wichmann) and the German Diabetes Center in Düsseldorf (Dr. Wolfgang Rathmann, Dr. Christian Herder; Direktor: Professor Michael Roden).

The MTNR1B gene is expressed in insulin-producing islet cells, among other cells, and encodes one of the two known melatonin receptors. It is assumed that this receptor inhibits the release of insulin via the neural hormone melatonin. The melatonin level in the body is high at night and declines in daylight, whereas the insulin level is higher during the day than in the night. Taken together, these new data implicate an association between the sleep-wake rhythm, the so-called circadian rhythm, and fasting glucose levels, which was not known previously.

Until now an efficient strategy for prevention and for therapies to treat the cause of the disease has been missing in diabetes research. The Helmholtz Zentrum München is working intensively on new approaches in the study and treatment of diabetes. Further studies will show which role melatonin plays in the regulation of insulin secretion, fasting glucose levels and the development of diabetes and whether this finding will lead to new treatment options.

January 13, 2008 (EurekAlert) - A benchmarking study published in the Journal of Hospital Medicine evaluated contemporary hospital glycemic management in United States academic medical centers, determining glucose control practices are suboptimal and do not meet current American Diabetes Association (ADA) hospital diabetes care standards.The retrospective cohort study was based upon a 2005 collaborative project by The University HealthSystem Consortium, an alliance of 103 academic health centers and 119 associated hospitals. The study found wide variation in performance of the recommended hospital diabetes care measures. Recommendations and guidelines from the ADA include the use of intravenous insulin to control hyperglycemia in critically ill patients, but the study found that intravenous insulin was used in less than half of ICU patients involved in the study.

"With the prevalence of diabetes in hospitalized adult patients ranging from 12 percent to 25 percent, it's vital for hospitals to use effective insulin therapy to control glucose levels in acutely ill patients." says Jeffrey B. Boord, MD, MPH, lead author of the study. "Tight glucose control can improve patient outcomes and decrease hospital stay."

Intravenous insulin use is associated with better overall glucose control in the study. The findings also indicate the need for more research into other opportunities to improve hospital care practices, such as standardized protocols for subcutaneous basal/bolus insulin regimens and increased frequency of A1C testing.